TWENTY-one years after the establishment of the Uniting Sydney Medically Supervised Injecting Centre (MSIC) research shows that, rather than becoming a “honeypot” the MSIC has led to improved and sustained public amenity, leading to a call for the establishment of more supervised injecting facilities.
“The MSIC was opened in 2001, following the 1999 New South Wales Drug Summit held in response to the 1990s heroin epidemic that saw sharp increases in opioid overdose death and ongoing blood-borne virus transmission,” authors, led by Associate Professor Carolyn Day, from the University of Sydney, wrote in the Medical Journal of Australia.
Day and colleagues addressed questions that have been a constant over the 21 years of the MSIC operation, including:
- Should injecting particularly dangerous drug mixtures, doses, or body sites be prohibited? – intoxicated clients are denied entry, but various substances considered dangerous drug mixtures have been injected at the MSIC, without fatality.
- What are the age limits and other restrictions? – only people aged 18 years or older, with a previous history of injecting, are legally permitted to access the MSIC.
- What is the medico-legal responsibility? – the MSIC policy prohibits staff from injecting clients and clients from injecting other clients. The medico-legal responsibility in the event of death remains untested because no overdose deaths have occurred onsite at the MSIC.
- Is the MSIC aiding, abetting and fostering more frequent drug use? – multiple evaluations undertaken throughout the first 10 years of the MSIC operation found no increased frequency of drug use among registered clients, results replicated at the Vancouver SIF.
- What are the risks of onsite buying and selling of drugs? -- the service design limits opportunities for such behaviour, including close staff oversight throughout the service. Where contentious behaviour is suspected, temporary exclusions from the service can be imposed.
- Is the MSIC effective for harm reduction? -- at the end of April 2022, the MSIC had supervised 1 232 951 injections with no deaths onsite, successfully managed 10 890 overdoses, and made 20 420 referrals to health and social services.
Despite the supporting evidence backing the MSIC and other facilities of its type, there are currently only about 120 supervised injecting facilities (SIFs) operating globally, with two in Australia.
“The MSIC remains the only NSW service, despite robust arguments for additional facilities in Sydney locations, where opioid overdose deaths have been increasing, including a NSW Special Commission recommendation for more SIFs and multiple Coronial recommendations,” wrote Day and colleagues.
“We have addressed key questions regarding SIF operations and contend that there is sufficient evidence to support SIF rollout and expansion.
“The key themes to emerge are that good policy, with clear legislation and careful management of clients within a harm reduction framework, can and does alleviate problems that may be perceived as inherent to the operation of such services.
“Given the solid evidence, current governments, in Australia and elsewhere, should expand SIF services without unnecessary protracted trial periods. The key challenge in SIF expansion is supporting legislation. In NSW, an amendment to current state legislation to permit more than one facility is required.
“Questions regarding the scientific and operational merit of SIFs have been answered,” Day and colleagues concluded.
“After 21 years of success, it is time for robust support for further services to be implemented both within Australia and internationally.”
- Cate Swannell